TCRN PhD Scholarship Top-up Awards 2013
Application Form
NOTE: Prior to completing this application form, ensure that you have done the following
 Read and understood all/any Guidelines relevant to the Scholarship being applied for
 Provided all relevant information and documentation. Incomplete applications or missing documents will result in
your application not being considered.
1. Scholarship Details
TCRN PhD Scholarship Top-up
Scholarship being applied for
First-year student: 3-year top-up
Second-year student: 2-year top-up
Final-year student: 1-year top-up
2. Applicant Details
UNSW student number:
Family Name:
Male
Female
Domestic Student
Postal address (home)
Number:
Street:
Suburb:
Postcode:
Home phone:
Email address:
Given name:
Date of birth (dd/mm/yyyy):
International Student
State:
Country:
Mobile:
3. Current Scholarships
Are you currently receiving any other awards or scholarships
at UNSW?
*If Yes or Pending, please provide information below
What is the name of the award/scholarship?
Yes*
Pending*
No
1.
2.
3.
1.
2.
3.
1.
2.
3.
What is the annual monetary value of the award(s)?
What is the exact duration of the award?
Please provide exact start and expiry date(s).
4. Current Program
4a. Enrolment Details
Faculty of Medicine (Only)
Date of commencement:
School:
Expected completion date:
Enrolment status:
Full-time
Part-time
Note: part-time students are not eligible for the award
4b. Supervisor Details
NOTE: Primary supervisor must be a listed TCRN member. Refer to Guidelines for further details.
Name of Primary Supervisor:
Name of Joint Primary Supervisor:
5. Academic Qualifications – Undergraduate & Postgraduate
Details of
previous
Study
Example
B.E
Name of award
held (if any)
Monetary
value
Period held
From
$
Institution
Years of
enrolment
From
To
Year
graduated
University of
XYZ
2002
2008
To
Translational Cancer Research Network
A translational cancer research centre program funded by the Cancer Institute NSW
Level 4 | Lowy Cancer Research Centre | The University of New South Wales | UNSW Sydney NSW 2052
T: +61 2 9385 1395 | tcrn@unsw.edu.au | www.tcrn.unsw.edu.au
2007
1 of 4
6. Relevant Research Experience
Briefly describe your previous research experience including any relevant employment. (max 250 words)
7. Research Publications
Provide citation details of any previous research publications. Indicate the publication category and where sole- or
first-authorship applies.
Conference
paper /
research
report
Book /
chapter
Peerreviewed
journal
article
First / sole
author
8. Research Plan
Topic Area:
Project Name:
Background:
Hypothesis/Aims:
Progress to-date:
Key objectives and milestones: Suggest to present milestones for each year of study
9. TCRN Core Strengths
To which (if any) of the following TCRN core strengths does your research apply?
Molecular basis of cancer
New therapeutics
Cancer epidemiology
Health services research
Adult cancer areas
Ovarian cancer
Brain tumours
Haematological malignancy
Clinical trials
Gastrointestinal tract malignancy
10. Translational Relevance
Describe how your research will translate into improvements in patient care and clinical outcomes (max 250 words)
11. Statistical Research Plan
1) Does your research plan include statistical analyses?
Yes
No (explain why not)
2) Will you require additional statistical support for your research?
Yes (describe any statistics training, e.g. course/workshop, you have already taken and outline the support you require)
No (explain why no statistical support is needed)
12. Consumer Engagement
Describe how your research has engaged/will engage cancer consumers in the planning, implementation and/or
information dissemination stages. (max 100 words)
Translational Cancer Research Network
A translational cancer research centre program funded by the Cancer Institute NSW
Level 4 | Lowy Cancer Research Centre | The University of New South Wales | UNSW Sydney NSW 2052
T: +61 2 9385 1395 | tcrn@unsw.edu.au | www.tcrn.unsw.edu.au
2 of 4
13. Checklist
The following checklist is designed to ensure that you have provided all documentation required for your application
to be processed. The checklist must be completed prior to submission. If there is any information that you are unsure
of, or if you require further information, please contact the TCRN Operations and Projects Team:
tcrngrants@unsw.edu.au
I have:
Fully completed this scholarship application form
Attached a copy of my competitively awarded scholarship application (e.g. APA or equivalent)
- Certified copies or originals of academic transcripts (clearly legible)
- Curriculum vitae
Attached a letter from my primary supervisor indicating that there are sufficient resources to complete the
research project in accordance with UNSW OH&S standards
Additional comments regarding your application:
14. Privacy Notification
The University of New South Wales (UNSW) acknowledges and respects the privacy of individuals. The information
you provide on this application for is “personal information” as defined by the Privacy and Personal Information Act,
1998 (NSW) (the Act). The information you provide is collected and held by the Translational Cancer Research
Network (TCRN) in order to assess your application and for administrative and statistical purposes. You have the
right of access to, and alteration of, the information concerning yourself in accordance with the Act and the UNSW
Privacy Management Plan. The TCRN will not disclose your personal information without consent and without due
cause, except as required by law. You have the right to refuse this consent, but if the consent is not given your
application may not be processed.
Applicant’s signature:
Date:
15. Declaration
Translational Cancer Research Network
A translational cancer research centre program funded by the Cancer Institute NSW
Level 4 | Lowy Cancer Research Centre | The University of New South Wales | UNSW Sydney NSW 2052
T: +61 2 9385 1395 | tcrn@unsw.edu.au | www.tcrn.unsw.edu.au
3 of 4
In submitting this application for a TCRN PhD Scholarship Top-up:
I have:
 Answered all questions on this form truthfully.
 Read the relevant Guidelines and understand the eligibility criteria and conditions of this award.
I agree to:
 Notify the TCRN of any change to the information I have given in this application.
 Authorise UNSW to obtain from any other educational institution or relevant authority, at anytime, details
which relate to my Scholarship application including information concerning my enrolment record,
examination results, enrolment variation and attendance.
 Abide by the TCRN conditions of the award, as amended from time to time.
 Comply with UNSW rules on admission, enrolment and other policies on the conduct of research.
 Undertake to obtain ethical clearance and satisfy any other regulatory requirements before commencing any
research to which those requirements may apply.
I understand that:
 UNSW may disclose information concerning this application to any person or body UNSW considers has
legitimate interest in receiving it and I consent to such disclosure.
 UNSW may vary or cancel any decision it makes if the information I have given is incorrect or incomplete.
 I will not be sent notification that my application has been received.
 I must not receive scholarships from different institutions simultaneously.
 UNSW is not responsible for the loss of any documents submitted.
 Submitted documents become property of UNSW.
 My application processing will be delayed if I have not provided all documents as detailed throughout the
form and on the checklist.
 If I am offered a scholarship, I will not be able to defer that offer.
 Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth).
 My application will not be processed if I have not confirmed that I agree with this Statement by signing
below and dating this application form with the date of submission.
16. Agreement
APPLICANT NAME
SIGNATURE
DATE
___ / ___ / ___
THE APPLICATION MUST BE LODGED BY THE CLOSING DATE: 23 January 2013
Email the application form and supporting documents, scanned as a single PDF, to tcrngrants@unsw.edu.au
NOTE – applicants may use the ACP printer/scanner on Level 4 of the Lowy Cancer Research Centre to scan and email all documentation
directly to the TCRN. Select recipient No. 079 (‘TCRN Grants’) from the address book.
Translational Cancer Research Network
A translational cancer research centre program funded by the Cancer Institute NSW
Level 4 | Lowy Cancer Research Centre | The University of New South Wales | UNSW Sydney NSW 2052
T: +61 2 9385 1395 | tcrn@unsw.edu.au | www.tcrn.unsw.edu.au
4 of 4